>Health and Nutrition>Cipro Now, Marathon in Ten Days
I am 5 days into a 10 day course of Cipro and 11 days out from marathon #5. So, I have consulted Dr. Google* and read all the RA threads I can manage, but I have a J.D. not an M.D. I don’t think the underlying infection will affect the race and am ok racing even if my taper is more of a cliff, but I remain concerned about this tendon rupture risk. Interested in opinions on two points:
- How much the tendon rupture risk will diminish over the week after the end of a 10 day Cipro course? The meta-study’s section on latency confused me.
- If the answer is “not much” or “not enough,” any idea whether switching to a different antibiotic family at my follow-up appointment (tomorrow) will make a difference?
- Is there any possibility that this risk never goes away? There’s a single case article about patellar tendon rupture one month out** but the half-life of the drug is 4 hours so is it leaving behind some kind of permanent damage?
The FDA warning says “tendon ruptures [n?] have occurred up to several months after” … but FDA doesn't say don't strain for several months even if you're feeling good. I feel like I don't have enough information to make an informed decision about the amount of risk I am accepting by taking this medicine. Running is important to me. I am loathe, but willing, to miss this race if I have to, but I can't see giving up running for "up to several months" without some more information.
I tried to find a literature-based consensus on this question a couple of years ago when I had to take some Cipro. What I found at the time was the mishmash of evidence which you have found so far.
I was never able to get a straight definitive answer from the literature, but while there is clearly an association between quinolones and tendon issues, I suspect some of the injuries are also idiosyncratic and not necessarily dose dependent.
As far as switching antibiotics, you've got to weigh the risk of potentially half-treating an infection as well. If I might ask: was the infection your doc is treating serious--did you really need 10 days of Cipro? (Even an uncomplicated pyelonephritis these days gets 7 days of antibiotics instead of 10.) If a culture was done, you can request your doc to check the culture results to see what the organism was sensitive to, and perhaps switch to an another antibiotic.
Trent posts here often and I'd be interested on his take.
PS: Since you're a JD, I can't resist: there's a company advertising on our local TV looking for clients who have taken Cipro )
It's always something..
There is a thread called No Running on cipro? on page 2 of this forum.
I don't know how to put in a link.
A Dance with Monkeys
Why did you agree to take cipro rather than an alternative? There are almost no infections for which cipro (or levaquin) are the only options. You are the boss of you.
Anyhow, there is no clear data but there is risk. Most of the risk seems to take place while taking the drug and diminishes afterwords. How fast? Who knows.
I'm running somewhere tomorrow. It's going to be beautiful. I can't wait.
Agreed to take cipro rather than the alternative because I was not aware / had not informed myself of the alternatives. I went to the ER for the first time in about 20 years, due to some serious pain around the site of a 3 year old complicated hernia repair (repair of a previously repaired hernia). I was concerned something had given way again. Doc said all seemed well but potentially an infection unrelated to the surgery and started me on that med, and I accepted the professional opinion in hopes of being well for the race. We did discuss running & racing, he did not mention the warning. I'll see the specialist tomorrow morning and will see if I can go off this now. Thank you all for the replies.
I find it odd that there was concern about an infection in or around the hernia and that it would simply be treated with an antibiotic without letting a surgeon look at it right then and there. In addition, if they thought it was simply an infection in the skin not requiring a surgical consultation, that is one of the last antibiotics I would have chosen. Last, I would expect in the emergency department that they would have checked blood counts before prescribing an antibiotic, and if your blood counts are normal it's unclear to me that you would actually need the antibiotics. That said, I did not examine you and they did.
I will add on the point that the doc did not mention anything about running on Cipro that there are thousands of medications and thousands of side effects and it is not humanly possible for any individual healthcare provider to remember it all. That is why it is paramount that individuals the active as well and educate themselves about their own medical conditions and treatments. Your doctor may be the best in the world but he or she cannot know everything about everything for everyone. Each patient however can take the time to educate him or herself about everything that they are doing for their own health condition. This is not an implication of the OP, who after all took the time to come and discuss this particular medication, but is rather a general soapbox statement.
Or, as I like to think about it, most doctors will see 20 to 40 patients in a day, and have to know everything about all those patients, while most patients only have to know about themselves.
Feeling the growl again
Each patient however can take the time to educate him or herself about everything that they are doing for their own health condition. This is not an implication of the OP, who after all took the time to come and discuss this particular medication, but is rather a general soapbox statement.
Agreed. The quagmire is that most patients lack the medical/physiology and biology/chemistry education necessary to intelligently process the required information. Nothing against the patients, they are probably educated well in other specialties. Understanding the differences between different classes of antibiotics is not something that will come easily to the average person. Even though I have ample relevant background to understand the information, I still routinely defer to my wife as she has the specific education to understand the particulars of selection medications. If I were to take a topic as far out of my area as medicine is for most people...say IT...I could study up on the internet all day long but a lot of things would still be Greek to me and I would be an idiot trying to make decisions without an IT expert giving input.
Ideally the patient would take the opportunity to share as many particulars as possible with their physician as the treatment decision is being made -- like the intention to soon run a marathon -- so that the physician can incorporate them into the decision, however given that the physician is under pressure to get onto the next patient in about 30 seconds, this too is difficult.
It is nice to see a physician so concerned about patients informing themselves and playing an active role in treatment decisions.
"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand
A Saucy Wench
Or - even if the patient DOES know about Cipro they can get a doc in a semi emergent situation who refuses to prescribe anything BUT Cipro and doesnt give a rats ass that you are a runner but more that they dont want to extend the time they deal with you from 2 minutes to 5. Then the patient has to go through the hell of letting the infection continue to run while trying to find a doctor who will consider something different.
I have become Death, the destroyer of electronic gadgets
"When I got too tired to run anymore I just pretended I wasnt tired and kept running anyway" - dd, age 7
There is the engaged patient, and then there is the angry patient...
We likely could benefit from some social science perspectives on communicating risks to patients in an understandable manner. After reading this stuff above, I took a look at two things: the patient instructions from the hospital and the Cipro package insert. The patient instructions (2 pages on Cipro) don't mention anything about risk of tendon injury -- the warnings relate to sensitivity to sunlight and not driving until its effects are known, etc. The package insert does have the black box at the top, but I have to admit that I actually skipped over that part the first time I read it. Cognitive effects of having read too much boilerplate in this life. I know my own profession has a lot of culpability for warning label pollution that renders all of them less effective. Perhaps a Checklist Manifesto for the patient.
Trent, my description of the symptoms was too brief. The surgery affected areas beyond (to the south) of the inguinal canal & involved removal of the 8 year old mesh, and the scar tissue that's left irritates things all around the area. I had an ultrasound, a CBC w differential, a metabolic profile, and a urinalysis. The doc was thorough and unhurried. I had time for questions but I didn't know what to ask. I don't think anyone failed to deliver care that's up to the standard - am not that kind of lawyer.
On the bright side, looking at the CBC results I see my hematocrit measure is 45%. Ready to race!
"Beginning in October, bottle caps of Extra Strength Tylenol will warn consumers the product contains acetaminophen and they should always read the label. The warning is the third element to highlight the ingredient on Extra Strength Tylenol but the redundancy may be necessary because consumers do not read labels. "
I did have one bit of advice: currently the exact mechanism of tendon injury from cipro is unknown. One of the theories is that it inhibits collagen production.
With this in mind, you might wish to be really conservative in your recovery period after the marathon. After the race, your body will be working hard to heal and recover from the cellular damage inflicted during the race. If Cipro inhibits collagen synthesis, that would likely make you even more vulnerable to injury than you normally would be during that time.
Just a thought....Have a great race!!!
Follow up for anyone interested: I went off the cipro after seeing the specialist six days out from ER. Took it easy for 3 days, then ran a final taper week similar to other final tapers I've done. Paid attenation to sensations in my lower legs / Achilles, got a few more opinions, ran my race. I don't think I've ruptured any tendons. Went out too fast - feeling just awesome with such little volume of late, and blew up at 20, running a 3:15 flat w/ a +9:00 or so split. Unless Cipro makes you stupid for weeks I can't blame it for that ugly split. Older and smarter now.